Surgical Salvage of Heart Rupture: Report of Two Cases and Review of the Literature

Bashour, Tali T.; Kabbani, Sami S.; Ellertson, David G.; Crew, John R.; Hanna, Elias S.

doi:10.1016/s0003-4975(10)60458-4

Cited by 55 publications

(9 citation statements)

References 20 publications

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“…23 Clinically, these patients have generally been severely hypoten- 15 Rupture of the myocardium sive, often in shock, with severe right sided heart failure and sometimes, but not very often, showing classical signs of pericardial tamponade. It has been suggested'9 that this condition might be more readily diagnosed at an early stage by echocardiography, since this technique can detect very small amounts of fluid (15-20 ml) in the pericardial sack.24 Table 4 shows previous studies together with the present series in which data indicate the presence of subacute heart rupture.…”

Section: Discussionmentioning

confidence: 99%

Rupture of the myocardium. Occurrence and risk factors.

Dellborg¹,

Held²,

Swedberg³

et al. 1985

Heart

111

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The occurrence of myocardial rupture was studied in a well defined unselected population of patients with acute myocardial infarction, and the group of patients who died of rupture of the heart were compared with two control groups. Of a total of 3960 patients, 1746 (44%) fulfilled the diagnostic criteria for acute myocardial infarction. Rupture was defined solely on the basis of the presence of a pathological passage through part of the myocardium, either the free wall of the left ventricle or the septum, found at necropsy or during operation. Two controls were selected for each patient and matched for age and sex, one (control group A) with acute myocardial infarction having died in hospital but not of rupture (non-rupture cardiac death) and one (control group B) with acute myocardial infarction having survived the hospital stay. Necropsy was performed in 75% of all fatal cases with acute myocardial infarction. The total hospital mortality was 19%, the highest mortality being among women over 70 years (29%). Ruptures (n = 56) were found in 17% of the hospital deaths, or 3.2% of all cases of acute myocardial infarction. Women aged less than 70 had the highest incidence of rupture, 42% of deaths being due to rupture. The mean age for patients with rupture and controls was 70.5 years. The median time after admission to death was approximately 50 hours for patients and control group A. Thirty per cent of the patients with rupture occurred within 24 hours of the initial symptoms occurring. Angina and previous acute myocardial infarction were more common among control group A. Patients with rupture and control group B were mostly relatively free of previous cardiovascular or other diseases (chronic angina pectoris ( > 2 months) and previous myocardial infarction). Sustained hypertension during admission to the coronary care unit was more common in patients than in control group A. Hypotension and shock were more common among control group A. Most (79%) of the patients who subsequently ruptured did not receive any corticosteroids at all during the hospital stay. Severe heart failure and antiarrhythmic treatment were more uncommon among patients than among control group A. Patients with rupture received analgesics approximately three times a day throughout their stay. Control group B received analgesics mostly during the first 24 hours. Thus female patients, patients with first infarcts, and patients with sustained chest pain should be investigated for the possibility of rupture. As many as one third (32%) of ruptures may be subacute, and therefore time is available for diagnosis and surgery.

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Section: Discussionmentioning

confidence: 99%

Rupture of the myocardium. Occurrence and risk factors.

Dellborg¹,

Held²,

Swedberg³

et al. 1985

Heart

111

View full text Add to dashboard Cite

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“…Ventricular rupture is a rare but fatal mechanical complication of AMI. Most cases were associated with death following cardiac tamponade and cardiogenic shock [5,6]. The incidence of ventricular rupture secondary to AMI was reported between 2 and 4% and responsible for 10-15% of hospital death [2,4,6].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Previous literatures demonstrated that patients with advanced age, female, and concomitant hypertension had a higher risk of cardiac rupture [2,3,5,6]. Some authors found that patients with the first episode of AMI, especially involving the massive infarction of anterior or lateral wall with high ST elevation, tend to develop this complication [2,3,9].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Firdaus

Rahim

Rusdi

et al. 2020

Case Reports in Cardiology

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“…Left ventricular free wall rupture occurs in up to 10% of the in-hospital deaths following acute MI (usually between 3 to 6 days) and the survival is associated with emergency operation [7]. In a large review of cases, the distribution of free-wall rupture location was inferolateral (posterior) wall segment (43%), lateral wall (28%), then apical wall (24%) followed by other segments at equal frequency [5].…”

Section: Discussionmentioning

confidence: 99%

Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically

Roa-Castro¹,

Molina-Bello²,

Valenzuela-Suárez³

et al. 2012

Case Reports in Vascular Medicine

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Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.

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Surgical Salvage of Heart Rupture: Report of Two Cases and Review of the Literature

Cited by 55 publications

References 20 publications

Rupture of the myocardium. Occurrence and risk factors.

Rupture of the myocardium. Occurrence and risk factors.

Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically

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